CERVICAL SPINE INJURY: PEDIATRICS

CERVICAL SPINE INJURY: PEDIATRICS
Presentation by:LEONARD E. SWISCHUK, M.D.
THE UNIVERSITY OF TEXAS MEDICAL BRANCH
GALVESTON, TX


CHILDHOOD INJURIES LESS COMMON THAN IN ADULTS
MORE INJURIES OCCUR IN THE UPPER CERVICAL SPINE IN INFANTS AND YOUNG CHILDREN WHY ?
APEX OF THE FLEXION CURVE IN UPPER SPINE
DIVIDE PATIENTS BY AGE GROUP
PREVERTEBRAL SOFT TISSUES
* Buckling and pseudothickening
* Full inspiration-extension
* Pharyngeal-tracheal stepoff
* Don’t spend too much time

OTHER PROBLEMS
* Infant and children are hypermobile
o Physiologic motion may be pronounced
* Immature spine
o Synchondroses, etc.

DENS FRACTURES

* Occur through dens body synchondrosis in infants
* In infants, not the same as in adults
* Fragmented os terminale, pseudo fracture
* Os odontoideum pseudo fracture

DENS FX ANTERIOR
OS TERMINALE
FRAGMENTED OS TERMIONALE NORMAL
PSEUDO FX OS ODNTOIDEUM
HANGMAN FRACTURES
* These occur in infants
* Heavy head is the mechanism
* Differentiate from congenital defects

CONGENITAL DEFECT
C2 SYNCHONDROSES (PSEDUOFRACTURES)
* Dens-body
* Dens-neural arch
* Oblique view
* CT-parasagittal view
* Aberrant synchondroses

FLEXION – ROTATION INJURIES
* Same as in adults
* Usually mid cervical spine
* Usually older children

FX WEDGING ANT HYPERFLEX
NORMAL ANTERIOR WEDGING
ANTERIOR SUBLUXATION (Physiologic)
HYPEREXTENSION INJURIES
WIDE DISC HYPEREXTENSION AND FX
FX POSTERIOR ARCH C1
CONGENITAL DEFECT POST ARCH C1
DISLOCATION C1 – C2
* Relatively uncommon overall
* Requires severe injury
* Can be seen in infants
* May disrupt blood supply to os terminale
DISLOCATION C1-C2
PREDENTAL DISTANCE
PREDENTAL DISTANCE 5 MM EXTENSION NORMAL
SAME PATIENT FLEXION 5MM NORMAL
RULE OF 2
INTERSPINOUS DISTANCE C1, C2
ABNORMAL C1-C2 DISLOCATION
NORMAL NO DISLOCATION
AXIAL LOAD INJURIES
* Same as in adults
* Usually older children

JEFFERSON FRACTURES
* Very rare in infants
* Differentiate from synchondroses

JEFFERSON FX
JEFFERSON FRACTURE
SYNCHONDROSES NORMAL
NORMAL - PSEUDO OFF SET - UP TO 2 YTS
INFANTS AND CHILDREN ARE HYPERMOBILE
TORTE COLLIS

SUGGESTED READING
* Platzer P, Manuela J, Thalhammer G, et al: J Trauma 62:389-396, Feb. 2007.
* Apple JS, Kirks DR, Merten DF, et al: Pediatr Radiol 17:45-49, 1987.
* Hadley MN, Babramski JM, Browner CM, et al: J Neurosurg 68:18-24, 1988.
* “Imaging of the Cervical Spine in Children” Swischuk, LE, 2002 Springer-Verlag, New York, pgs. 75-121.

CERVICAL SPINE INJURY: PEDIATRICS.ppt